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Content ArticleIn this blog, Kerry Robinson, director of performance, improvement and organisational development at The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, describes a systemic approach to quality improvement that involves board members having a visible role in the process. The aim is to ensure the board's actions match up with the rhetoric on leadership for improvement. Kerry explains the actions she is personally taking as a board member to lead by example in quality improvement.
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Content ArticleA Patient Safety Huddle is a brief multidisciplinary daily meeting held to discuss threats to patient safety and actions to mitigate risk. This evaluation of The Huddle Up for Safer Healthcare (HUSH) project in BMC Health Services Research aims to assess the impact on teamwork and safety culture of the project, which implemented PSHs in 92 wards at five hospitals, across three NHS Trusts. This paper also seeks to add to the evidence-base around huddles as a mechanism for improving safety.
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Content ArticleThis short article describes how maternity and neonatal teams across Herefordshire and Worcestershire Local Maternity and Neonatal System (LMNS) have been using video conferencing technology to drive safety improvements for mothers and babies, thanks to the launch of their new daily digital safety huddles.
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Content ArticleIn this blog for the Nursing Times, Fiona Hibberts, head of the Nightingale Academy and consultant nurse at Guy's and St Thomas' NHS Foundation Trust, discusses the importance of huddles in improving patient safety and care, and in providing emotional support for staff. The author describes a huddle as "a gathering of key individuals, at a given time, to briefly discuss safety aspects of care of a group of patients in real time, escalate concerns and make plans," and highlights their importance for staff morale during the COVID-19 pandemic.
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Content ArticleThis guidance was updated on the 30 June 2022 to clarify how healthcare professionals should apply the term “unexpected or unintended” to decide if something qualifies as a notifiable safety event or not. Further detail is included below and you can find the full update here.
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Content ArticleThis article in Social Science & Medicine examines how GPs and patients explore medical and existential uncertainty in consultations. The authors analysed 20 naturally occurring clinical consultations between general practitioners and patients in England, focusing on interactions and how they negotiated uncertainty. They found that the doctor-patient dynamic contributes significantly to the way in which medical uncertainty is discussed. By conceptualizing uncertainty in an indirect and depersonalized manner, GPs manage to safeguard against clinical errors without compromising their authority and credibility.
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Content ArticleThis research by the Nuffield Trust, commissioned by NHS England and NHS Improvement, explores the business case for overseas recruitment and looks at the factors that attract or deter nurses from choosing to work in the UK. With a current NHS nursing vacancy rate of 10% and ambitious national goals to expand the workforce, recruiting nurses from overseas is an essential part of the picture. In this research, the authors look at the costs and benefits of overseas recruitment and present their findings as a briefing paper, research report and review on factors that attract or deter staff from moving to the UK.
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Content ArticleThe pandemic has severely disrupted cancer services in England with major consequences for survival rates for lung, breast and colorectal cancer. This paper from the Institute for Public Policy Research examines the impact of the pandemic on cancer pathways, highlighting widespread disruption across screening, referrals, diagnostic and treatment services. The authors also highlight that the 'missing patient' backlog is difficult to predict and that there is a lack of qualified staff to increase capacity and aid service recovery.
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Content ArticleLong waiting times and growing waiting lists for hospital treatment have been a problem for some time, but the COVID-19 pandemic has exacerbated the issue and waiting lists have grown rapidly. This analysis of waiting list data by The King's Fund shows a clear relationship between longer waiting lists and deprivation, with those living in the most deprived areas nearly twice as likely to wait more than a year for treatment compared to those living in the least deprived areas.
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Content ArticleWhile the NHS delivered a remarkable amount of elective treatment during the pandemic, the pressure of caring for large numbers of patients seriously unwell with COVID-19 has led to the waiting list for elective care reaching the highest level since current records began. This analysis from The Health Foundation looks in detail at the impact of the pandemic on the waiting list for elective care in England. It highlights that: 6 million fewer people completed elective care pathways between January 2020 and July 2021 than would have been expected based on pre-pandemic numbers the backlog of elective care is not evenly distributed across England patients living in socioeconomically deprived areas faced more disruption and delays than those in England’s least deprived areas. It also looks at the difficulty in predicting how long the backlog will take to clear and how much it will cost. One unknown factor that complicates this task is 'missing' patients - those who did not or could not seek care during the pandemic. These patients may present at a healthcare setting requiring more urgent, intensive treatment as a result of missing out on earlier intervention.
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Content ArticleThis report by the National Audit of Dementia (NAD) presents the results of the fifth round of audit data. For the first time, the audit has been undertaken prospectively, which will enable hospitals to take earlier action to improve patient care and experience. However, this has demonstrated that many hospitals still have no ready mechanism to identify people with dementia once admitted. One notable improvement is delirium screening (dementia is the biggest risk factor for developing delirium). Screening for delirium has improved from 58% in round 4 to 87% in the current audit. In addition, a high number of pain assessments are also being undertaken within 24 hours of admission (85%). Although encouraging, the report highlights that 61% of these assessments were based only on a question about pain—an approach that can be unreliable in patients with dementia. While this report acknowledges that our health services have experienced an extraordinarily difficult and challenging time, it does shine a light on a need for more training. It states that is encouraging that many staff have received Tier 1 dementia training (median 86%), but suggests that a much higher proportion of ward-based patient facing staff should have received Tier 2 dementia training (median 45%). It found that only 58% of hospitals are able to report the proportion of staff who have received training. As such, the report recommends that any member of staff involved in the direct care of people with dementia should have Tier 2 training, and this training should be recorded to provide assurance to the public and regulators.
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Content ArticleThis report by the Royal College of Midwives (RCM) highlights the impact of midwifery staffing shortages on women. It looks at historical failures to invest appropriately in maternity services and talks about a mounting maternity crisis, drawing attention to Care Quality Commission inspections of maternity services that are identifying concerns around safety directly linked to staffing shortages. According to the report’s findings, if the number of NHS midwives in England had risen at the same pace as the overall health service workforce since the last general election, there would be no midwife shortage; there would be 3,100 more midwives in the NHS, rather than having a shortfall of 2,500 full-time midwives. The RCM published the results of a survey last month which showed that midwives give 100,000 hours of free labour to the NHS per week to ensure safe care for women. It also showed that staffing levels were repeatedly cited as cause for concern around the safety of care, and that midwives and maternity support workers are exhausted and burnt out.
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Content Article9.1 million people will be living with major illness by 2040, 2.5 million more than in 2019, according to this new report published by the Health Foundation. The analysis is part of a four-year project led by the Health Foundation’s Real Centre in partnership with the University of Liverpool, focusing on levels of ill health in the adult population in England up to 2040. It lays out the scale and impact of the growth in the number of people living with major illness as the population ages.
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Content ArticleThis policy explains how the Structured Judgement Review (SJR) process is implemented within Maidstone and Tunbridge Wells NHS Trust. The policy advises staff on how to undertake a mortality case record review, which documentation to use, in which circumstances an SJR is required and how the new process relates to previous systems and processes. The policy also explains how the process links to revised mortality reporting, escalation of concerns and dissemination of learning. It covers all inpatients and Emergency Department patients who die whilst in the Trust’s care, and patients who die within 30 days of discharge.
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Content ArticleIn this report, Patient Safety Learning considers the roles and responsibilities of Integrated Care Systems (ICSs) in relation to patient safety, and how this fits in with the wider patient safety landscape in England. This article contains a summary of the report, which can be read in full here or from downloading the attachment below.
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Content ArticleThis report summarises the key insights from the Birmingham ICS Delivery Forum event, held in Birmingham in April 2023. It places the discussions that took place into the broader context of health and care transformation, both at a local and national level, and uses wider sources and research to expand upon the key points.
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Content ArticleNHS services have been under increasing pressure in recent years, particularly since the start of the Covid-19 pandemic. We have previously reported on the NHS’s efforts to tackle the backlogs in elective care and its progress with improving mental health services in England. This report gives an overview of NHS services that may be used when people need rapid access to urgent, emergency or other non-routine health services, and whether such services are meeting the performance standards the NHS has told patients they have a right to expect. It covers: general practice community pharmacy 111 calls ambulance services (including 999 calls) urgent treatment centres accident and emergency (A&E) departments.
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Content ArticleIn this blog Aiden Fowler, the National Director of Patient Safety in England and a Deputy Chief Medical Officer at the Department of Health and Social Care, reflects on progress made in implementing the NHS Patient Safety Strategy, four years on from its publication. He outlines some of the main programmes of work associated with this and considers their impact on avoidable harm in the NHS.
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Content ArticleThis standard has been produced by NHS England to promote consistent delivery and quality of specialist orthodontic care provision to patients in England. It aims to ensure that resources invested by the NHS in specialist care are used in the most effective way, provide the best possible quality and quantity of care for patients and meet need rather than serve demand. The standard includes the following information: What is orthodontics? Complexity assessment Illustrative patient journey Assessing need Understanding current provision Model of care Clinical standard National key performance indicators Quality and outcome measures
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Content ArticleDespite their widespread use, the impact of commissioners’ policies for body mass index (BMI) for access to elective surgery is not clear. Policy use varies by locality, and there are concerns that these policies may worsen health inequalities. This study in BMC Medicine aimed to assess the impact of policies for BMI on access to hip replacement surgery in England. The authors used National Joint Registry data for 480,364 patients who had primary hip replacement surgery in England between January 2009 and December 2019. They found that rates of surgery fell after localities introduced policies restricting access to surgery based on BMI, whereas rates rose in localities with no policy. Localities with BMI policies have higher proportions of independently funded surgery and more affluent patients receiving surgery, indicating increasing health inequalities, and policies enforcing extra waiting time before surgery were associated with worsening mean pre-operative symptom scores and rising obesity. The authors recommend that BMI policies involving extra waiting time or mandatory BMI thresholds are no longer used to reduce access to hip replacement surgery.
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Content ArticleThe Department of Health and Social Care is seeking views and ideas on how to prevent, diagnose, treat and manage the six major groups of health conditions that most affect the population in England. These are: cancers cardiovascular disease, including stroke and diabetes chronic respiratory diseases dementia mental ill health musculoskeletal disorders The views and ideas gathered will inform the priorities and actions in the major conditions strategy. The consultation will close at 11:59pm on 27 June 2023.
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Content ArticleSocial care in England entered the pandemic in a fragile state. With much already written about the government’s response to the Covid-19 pandemic in the social care sector, this new report from the Nuffield Trust in collaboration with the Care Policy and Evaluation Centre analyses the structural and systemic factors that influenced that initial national response. Covid had far-reaching impacts on social care and exacerbated many longstanding issues. This work seeks to highlight progress and identify where action is needed to create a more resilient system.
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News Article
England has highest death rates of older patients in western world, study finds
Patient Safety Learning posted a news article in News
England has the highest death rates of frail and older hospitalised patients in the western world, a landmark global study has found. Harvard University, the London School of Economics (LSE) and the thinktank Health Foundation, all part of the International Collaborative on Costs, Outcomes and Needs in Care (Icconic), a global network of healthcare researchers, used thousands of official medical records to compare the cost and quality of care in 10 OECD (Organisation for Economic Co-operation and Development) countries. Patient deaths are commonly used measures of performance in healthcare systems but until now there have been few sources of comparable death rates across countries. In order to assess outcomes in frail and older patients, researchers focused on two groups that represent priority areas for the NHS and other healthcare systems: those in hospital with a hip fracture and those admitted with heart failure who have diabetes. On both measures, England had higher mortality rates than all the other countries, which included the US, Germany, France, Sweden and Spain. Dr Jennifer Dixon, the chief executive of the Health Foundation, said: “The findings of the Icconic study warrant urgent further investigation, particularly the finding of higher mortality among patients with hip fracture in the year after their admission for emergency treatment." “That patients in England with hip fracture spend far longer in hospital after surgery than they would in other countries also highlights an opportunity to improve efficiency by reducing the avoidable use of hospital care. Less avoidably long stays would mean existing capacity could be better used to address the backlogs in hospital care as a result of the pandemic. This could contribute to both better outcomes for patients and, as hip fracture is the most common reason for emergency surgery, significantly improved productivity for hospitals across the country.” Read full story Source: The Guardian, 10 November 2021 -
Content ArticleThis document summarises the findings of The Health Foundation's analysis on workforce supply and demand in general practice in England up to 2030/31. It focuses on patient care staff including GPs and general practice nurses. The Health Foundation developed three scenarios of potential workforce supply through a mix of in-house modelling and publicly available data: a scenario based on current policy, a more optimistic scenario and a pessimistic scenario. The analysis demonstrates that in all three scenarios, the supply of GPs and general practice nurses is projected to fall short of demand. Under current policy, the NHS faces a shortfall of over 1 in 4 GP and general practice nurse posts by 2030/31. In the pessimistic scenario this increases to around 1 in 2 GP and nurse posts, raising concerns about patient safety, quality of care and equity of access. In the optimistic scenario, the GP shortfall can be substantially mitigated by 2030/31, but this would require sustained and concerted policy action to boost GP retention and integrate newer roles within multidisciplinary practice teams.
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Content ArticleThis observational study in The Lancet Public Health analysed the effects of outsourcing health services to private, for-profit providers. The authors evaluated the impact of outsourced spending to private providers on treatable mortality rates and the quality of healthcare services in England, following the 2012 Health and Social Care Act. The authors found that: an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0·38% in the following year. changes to for-profit outsourcing since 2014 were associated with an additional 557 treatable deaths across the 173 CCGs in England. They conclude that private sector outsourcing corresponded with significantly increased rates of treatable mortality, potentially as a result of a decline in the quality of health-care services.
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